Middle Age, Not Old Age, May Be Loneliest Time of Life for U.S. Adults

Credit: Adobe Stock/Kateryna

Forget what you may have heard — loneliness does not wait until old age. A major study shows middle-aged adults, particularly those in the U.S., may be even more vulnerable, often overlooked in public health efforts despite juggling careers, caregiving and social isolation.

“There is a general perception that people get lonelier as they age, but the opposite is actually true in the U.S., where middle-aged people are lonelier than older generations,” said lead researcher Robin Richardson, Ph.D., a social and psychiatric epidemiologist and assistant professor at Emory University’s Rollins School of Public Health, in a news release. “Advocacy and interventions to address the loneliness epidemic have historically focused on older adults and adolescents. Middle-aged adults represent a critical population that is being overlooked.”

Led by researchers at Emory University, in collaboration with a multinational team representing institutions from the U.S., Canada and Chile, the study was launched to better understand the relationship between age and loneliness and how this might vary across countries. To do so, researchers designed their study to investigate the contribution of demographic and health factors to age-related inequalities in loneliness both within and across countries.

The UCLA three-item loneliness scale is a condensed version of a larger evaluation measuring loneliness. The three-item version asks these questions:


• How often do you feel that you lack companionship?
• How often do you feel left out?
• How often do you feel isolated from others?

Response options for each question included “hardly ever,” “some of the time” or “often,” with potential scores ranging from 0 (responding “hardly ever” to each of 3 questions) to 6 (responding “often” to each of 3 questions).

To ensure the accuracy of their results, researchers designed their analysis to account for several factors, including sex, educational level, marital status, child status and work status.

The study included over 64,000 adults aged 50 and older from 29 countries, with an average age of 68 years and 58% women. Researchers looked at self-reported loneliness, demographic characteristics and health status to understand patterns across different national and cultural contexts.

Loneliness levels differed widely between countries. Denmark reported the lowest average loneliness score (0.4), while Greece and Cyprus had the highest (1.7). Education levels and self-rated health also varied dramatically — for example, only 9.1% of older adults in Germany had less than a secondary education, compared with 82.1% in Mexico. Poor self-rated health ranged from 19.1% in Switzerland to 75.3% in Latvia.

When looking at how loneliness changed with age, researchers found the patterns again varied from country to country. In some countries like Greece and Slovakia, loneliness increased with age. In others, like Luxembourg and the U.S., loneliness decreased in older age groups.

A statistical measure called the Concentration Index (COIN) was used to summarize these age-related inequalities. Positive COIN values meant loneliness was more common among older adults, which was the case in most countries, although some — like Austria, Germany and Switzerland — showed little or no age-related inequality.

The study also explored what explained these differences. Not working was the top contributor to age-related loneliness, explaining nearly 20% of the inequality across countries. Being unmarried (16.1%), probable depression (12.9%) and poor self-rated health (9.9%) were also key factors. However, their effects varied by country. For example, not working increased loneliness among older adults in Latvia, but in the U.S., it was linked more to loneliness in middle age.

Some factors — like sex, obesity and not having children — had little impact on age-related loneliness in any country. Researchers pointed out 20% of the variation in loneliness by age was not explained by the factors studied, and this unexplained portion was mostly found in middle-aged adults.

“Our findings show that loneliness is not just a late-life issue,” added senior researcher Esteban Calvo, Ph.D., M.S.P.H, the dean of social sciences and arts at Universidad Mayor in Chile, in the news release. “In fact, many middle-aged adults — often juggling work, caregiving and isolation — are surprisingly vulnerable and need targeted interventions just as much as older adults. Globally, we must extend depression screenings to middle-aged groups, improve support for those not working or unmarried, and adapt these efforts to each country’s context — because a one-size-fits-all approach will not solve this worldwide problem.”